ABSTRACT
BACKGROUND: Autologous anterior iliac crest bone graft is still widely considered the gold standard for anterior cervical fusion after discectomy or corporectomy. Postoperative pain at the donor site is one of the main disadvantages to this technique. This prospective study aimed to evaluate pain at the donor site, after careful, standardised bone harvesting. METHODS: From March 2003 to March 2004, a prospective study was performed in a single neurosurgical department on 50 patients who underwent anterior iliac crest bone harvesting using a standard and careful surgical technique. During a one year follow-up, patient donor site pain was assessed with a Visual Analogous Scale (VAS) at 2, 7 and 60 days from surgery and finally, by a telephone interview, at one year. FINDINGS: The duration of time in hospital ranged from 4 to 9 days. On the 2(nd) day after surgery, pain, according to the VAS score, was recorded as being >7 by 4 patients (8%), 5-7/10 by 27 patients and >5/10 in 19 cases. On the 7(th) day after surgery, none of the patients reported any VAS > 7, 1 patient's VAS score was 6/10 and 49 patients had a VAS < 5. At 2 month follow-up, 45 patients were completely without pain (VAS 0) and the remaining 5 had a VAS < 5. At one year, 46 patients reported no pain (one patient was lost to follow-up); three continued to have pain <5 in VAS scale. CONCLUSIONS: After harvesting of bone from the iliac crest, using a standardised approach based on anatomised principles, most patients do not experience persisting pain at the donor site.
Subject(s)
Ilium/surgery , Pain, Postoperative/etiology , Tissue and Organ Harvesting/adverse effects , Adult , Aged , Cervical Vertebrae , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Prospective Studies , Spinal Diseases/surgery , Spinal Fusion , Time FactorsABSTRACT
A new technique of microplates/screws application for bone flap refixation is described. The microplates are fitted into a shaped bone groove in such a way that the hardware is flush with the edges of the groove thus avoiding definite palpable scalp prominence of the skin under hairless portions of the scalp.
Subject(s)
Bone Plates , Bone Screws , Craniotomy/methods , Skull/surgery , Surgical Flaps , Neurosurgical Procedures/instrumentation , Orthopedic Procedures/instrumentation , TitaniumABSTRACT
INTRODUCTION: To report the incidence, treatment and outcome of occipital condyle fractures (OCFs) based on the experience of a single neurosurgical department over a period of two years. MATERIAL AND METHODS: From April 1999 to April 2001, ten cases of OCFs were identified in 110 cervical traumas observed over a period of two years. Patients were studied by cervical x-rays, high-resolution CT scan with a 1-2 mm slice of the cranio-cervical junction (CCJ) and MRI in selected cases to evaluate the integrity of supporting ligaments. According to the Anderson and Montesano classification, 5 cases of type III, 3 cases of type II and 2 cases of type I fractures were found. Dysfunction of lower cranial nerves was observed in 8 cases. Treatment was conservative in all cases. RESULTS: At follow-up, ranging from 18 months to 2 years, fusion was obtained in all cases; 8 patients were neurologically intact, one patient presented a mild persistent dysphonia and another mild trapezius weakness. CONCLUSION: OCFs are actually not rare, rather they are often overlooked. In cases of high-energy trauma of the cervical spine, the diagnostic suspicion should be kept in mind.High-resolution CT scan with slice at 1-2 mm of the CCJ is the key radiological examination in the diagnosis of this lesion. Conservative treatment using a hard collar is sufficient to obtain sound fusion.
